Synovial chondromatosis is a rare entity characterized by metaplastic cartilage formation within the synovial connective tissue and the shedding of loose bodies into the joint. Of the four cases of synovial chondromatosis, experienced by authors, three involved the knee joint and one the proxiaml phalanx of the left index finger. A huge chondroma was found in the knee joint of 2 years old boy and the other one in the proximal phalanx of the left index of 11 years old girl. Histological findings disclosed the metaplastic transformation of synovium into cartilage in all cases.
Cartilage ; Chondroma ; Chondromatosis, Synovial ; Connective Tissue ; Female ; Fingers ; Humans ; Joints ; Knee Joint ; Male ; Synovial Membrane

Ossification of the anterior longitudinal ligament of the spine was first reported by Dr. Forestier and Dr.Rotes in 1950. However, in no other countries but Japan there have been reports on the ossification of the posterior longitudinal ligament of the spine which was first reported by Tsukimoto in 1960. About 45% of ossification of the posterior longitudinal ligament of the spine have a combination of ossification of the anterior longitudinal ligament and yet it is considered to be a variety of the spinal geriatric conditions, favorable to the cervical spine. The condition develops similar symptoms of cervical spondylosis. Authors report two cases of ossification of posterior longitudinal ligament of cervical spine of Korean nationals at St. Marys hospital, Catholic Medical College.
Japan ; Longitudinal Ligaments ; Ossification of Posterior Longitudinal Ligament ; Spine ; Spondylosis

PURPOSE: This study aimed to evaluate the clinical significance of microscopic invasion to determine the adequate resection margin in early gastric cancer (EGC). MATERIALS AND METHODS: A retrospective review was performed that included patients who underwent gastrectomy for clinical early gastric cancer (cEGC) at Seoul National University Hospital between January 2007 and December 2010. After subtracting the microscopic resection margin from the gross resection margin for each proximal or distal resection margin, microscopic invasion was represented by the larger value. Microscopic invasion and its risk factors were analyzed according to the clinicopathologic characteristics. RESULTS: In total, 861 patients were enrolled in the study. Microscopic invasion of cEGC was 6.0±12.8 mm, and the proportion of patients with microscopic invasion ≥0 mm was 78.4%. In the risk group, tumor location, pT stage, and differentiation did not significantly discriminate the presence of microscopic invasion. The microscopic invasion of EGC-IIb was 13.9±16.8 mm, which was significantly greater than that of EGC-I. No linear correlation was observed between the overall tumor size and microscopic invasion (R=0.030). The independent risk factors for microscopic invasion ≥20 mm were EGC-IIb vs. EGC-I/IIa/IIc/III (odds ratio [OR], 3.103; 95% confidence interval [CI], 1.533–6.282; P=0.002) and male vs. female sex (OR, 1.655; 95% CI, 1.012–2.705; P=0.045). CONCLUSIONS: Male sex and EGC-IIb were independent risk factors for microscopic invasion ≥20 mm. Examination of intraoperative frozen sections is highly recommended to avoid resection margin involvement, especially in cases of EGC-IIb.
Female ; Frozen Sections ; Gastrectomy ; Humans ; Male ; Retrospective Studies ; Risk Factors* ; Seoul ; Stomach Neoplasms*

Liver infarction and acrodermatitis enteropathica are rare complications of chronic pancreatitis. This report shows the case of a 56-year-old man who developed liver infarction due to portal vein thrombosis from chronic pancreatitis and acrodermatitis enteropathica during the course of his treatment. The rare combination of these complications in a patient with chronic pancreatitis has never previously been reported in the literature.
Acrodermatitis/*etiology/pathology/therapy ; Chronic Disease ; Human ; Infarction/*etiology ; Liver/*blood supply ; Male ; Middle Aged ; Pancreatitis/*complications ; Portal Vein ; Venous Thrombosis/complications/etiology ; Zinc/administration & dosage/deficiency

PURPOSE: This study evaluated the adequacies of lymph node (LN) dissection according to the second version (determined by tumor location) or third/fourth version (determined by surgery extent) of the Japanese gastric cancer treatment guidelines.METHODS: Prospectively collected data of 3,948 gastric cancer patients who underwent gastrectomy were analyzed. The prevalence of LN metastasis and 5-year survival were analyzed according to tumor invasion depth and tumor location. In early gastric cancer (EGC), the frequency of LNs were evaluated. In advanced gastric cancer (AGC), the frequency of LN metastasis and the 5-year survival rate of patients with positive LN were evaluated.RESULTS: For lower-third EGC, the positive rates for the #1 and #4sb were 0.93% and 0%. For upper-third EGC, the positive rates for #4d, #5, #6, and #11p were 0.3%, 0%, 0.76%, and 1.22%. For lower-third AGC, the positive rates for #4sb and #14v were 2.48% and 7.64%, and the 5-year survival rates were 69.2% and 12.5%, respectively. For upper-third AGC, the positive rates for #5, #6, and #12a were 2.33%, 2.57%, and 2.03%, and the 5-year survival rates were 21.8%, 64.3%, and 0%, respectively.CONCLUSION: According to our analysis, in EGC, LN dissection in second edition seems more suitable, however LN dissection in #11p would be mandatory in upper third EGC. In AGC, LN dissection in third/fourth edition seems more suitable in terms of frequency of LN metastasis and survival rate.
Asian Continental Ancestry Group ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Prevalence ; Prospective Studies ; Stomach Neoplasms ; Survival Rate

Purpose: To evaluate the feasibility and safety of intracorporeal overlapping gastrogastrostomy between the proximal anterior wall and antrum posterior wall (PAAP;PAAP anastomosis) of the stomach in minimally invasive pylorus-preserving gastrectomy (PPG) for early gastric cancer (EGC). Materials and Methods: From December 2016 to December 2019, 17 patients underwent minimally invasive PPG with PAAP anastomosis for EGC in the high body and posterior wall of the stomach. Intraoperative gastroscopy was performed with the rotation maneuver during proximal transection. A longer antral cuff (>4–5 cm) was created for PAAP than for conventional PPG (≤3 cm) at the point where a safe distal margin and good vascular perfusion were secured. Because the posterior wall of the proximal remnant stomach was insufficient for intracorporeal anastomosis, the anterior wall was used to create an overlapping anastomosis with the posterior wall of the remnant antrum. The surgical and oncological outcomes were analyzed, and the stomach volume was measured in patients who completed the 6-month follow-up. The results were compared to those after conventional PPG (n=11 each). Results: PAAP anastomosis was successfully performed in 17 patients. The proximal and distal resection margins were 2.4±1.9 cm and 4.0±2.6 cm, respectively. No postoperative complications were observed during the 1-year follow-up esophagogastroduodenoscopy (n=10). The postoperative remnant stomach (n=11) was significantly larger with PAAP than with conventional PPG (225.6±118.3 vs. 99.1±63.2 mL; P=0.001). The stomach length from the anastomosis to the pylorus was 4.9±2.4 cm after PAAP. Conclusions PAAP anastomosis is a feasible alternative for intracorporeal anastomosis in minimally invasive PPG for highly posteriorly located EGC.

Purpose: This study aimed to compare the surgical and oncological outcomes between totally laparoscopic pylorus-preserving gastrectomy (TLPPG) with intracorporeal anastomosis and laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) with extracorporeal anastomosis. Materials and Methods: A retrospective analysis was performed in 258 patients with cT1N0 gastric cancer who underwent laparoscopic pylorus-preserving gastrectomy using two different anastomosis methods: TLPPG with intracorporeal anastomosis (n=88) and LAPPG with extracorporeal anastomosis (n=170). The following variables were compared between the two groups to assess the postoperative surgical and oncological outcomes: proximal and distal margins, number of resected lymph nodes (LNs) in total and in LN station 6, operation time, postoperative hospital stay, and postoperative morbidity including delayed gastric emptying (DGE). Results: The average length of the proximal margin was similar between the TLPPG and LAPPG groups (2.35 vs. 2.73 cm, P=0.070). Although the distal margin was significantly shorter in the TLPPG group than in the LAPPG group (3.15 vs. 4.08 cm, P=0.001), no proximal or distal resection margin-positive cases were reported in either group. The average number of resected LN was similar in both groups (36.0 vs. 33.98, P=0.229; LN station 6, 5.72 vs. 5.33, P=0.399). The operation time was shorter in the TLPPG group than in the LAPPG (200.17 vs. 220.80 minutes, P=0.001). No significant differences were observed between the two groups in terms of postoperative hospital stay (9.38 vs. 10.10 days, P=0.426) and surgical complication rate (19.3% vs. 22.9%), including DGE (8.0% vs. 11.8%, P=0.343). Conclusions The oncological safety and postoperative complications of TLPPG with intracorporeal anastomosis are similar to those of LAPPG with extracorporeal anastomosis.

No abstract available.
Blastocyst ; Coculture Techniques ; Fertilization ; Oocytes* ; Sperm Injections, Intracytoplasmic ; Sperm Retrieval* ; Spermatozoa*

PURPOSE: Gastric cancer with lymph node metastasis (LNM) more than 15 (N3b) was defined as stage IV until the 6th AJCC system. However, it has been reclassified as a localized disease (stage IIb or III) since the 7th system. The aim of this study is to demonstrate that the survival of N3b is comparable to cytology-only positive (CY1-only) stage IV and to propose a new TNM system interpreting N3b as an eligibility criterion for receiving more intensive chemotherapy regimens. MATERIALS AND METHODS: 1,430 patients who underwent gastric cancer surgery at Seoul National University Hospital from 2007 to 2012 were retrospectively analyzed. The 5-year survival rate (5YSR) and 3-year recurrence-free survival (RFS) were evaluated according to the 7th and 8th systems, as well as a new categorization based on N-classification; N0-2 (LNM<7), N3a (LNM 7–15), or N3b (LNM>15). RESULTS: The survival of N3b is comparable to that of CY1-only stage IV (log rank test, P=0.671) and is distinct from that of grossly stage IV (log rank test, P<0.001). The survival of the remaining stage IIIc (T4bN3a) was comparable to those of N3b and CY1-only stage IV. Most N3b patients had significantly shorter 3-year RFS and mean RFS than those with IIb–IIIc, as if N3b itself was a higher TNM stage. CONCLUSIONS: In terms of survival, T4bN3a, N3b, and CY1-only stage IV were unified as stage IVa, while grossly stage IV was defined as stage IVb. N3b can be regarded as an eligibility criterion for undergoing more intensive chemotherapy regimens.
Classification ; Drug Therapy ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Retrospective Studies ; Seoul ; Stomach Neoplasms ; Survival Rate

Purpose: The European Organization for Research and Treatment of Cancer quality of life (QOL) questionnaires (QLQ-C30, QLQ-OG25, and QLQ-STO22) are widely used for the assessment of gastric cancer patients. This study aimed to use these questionnaires to evaluate QOL in postgastrectomy patients. Methods: We prospectively evaluated 106 patients with distal gastrectomy (DG), 57 with pylorus-preserving gastrectomy (PPG), and 117 with total gastrectomy (TG). Body weight and QOL questionnaires were evaluated preoperatively and postoperatively (at 3 weeks, and 3, 6, and 12 months). Results: TG patients had significantly more weight loss than DG/PPG patients. Compared with DG, patients after PPG had less dyspnea (P = 0.008) and trouble with coughing (P = 0.049), but more severe symptoms of insomnia (P = 0.037) and reflux (P = 0.030) at postoperative 12 months. Compared with DG/PPG, TG was associated with worse body image, dysphagia, eating, and taste in both OG25 and STO22. Moreover, OG25 revealed worse QOL in the TG group with respect to odynophagia, eating with others, choked when swallowing, trouble talking, and weight loss. The QOL of patients who received chemotherapy was worse than those in the chemo-free group in both physical functioning and symptoms such as nausea/vomiting, appetite loss, and trouble with taste; however, these side effects would soon disappear after finishing chemotherapy. Conclusion PPG was similar to DG in terms of postoperative QOL and maintaining body weight, while TG was always inferior to both DG and PPG. Adjuvant chemotherapy can affect both body weight and QOL despite being reversible.